Health Care Quality and Outcomes (HCQO) 2018-19 Indicator ... · q31.1 congenital subglottic stenosis q31.2 laryngeal hypoplasia q31.3 laryngocele q31.5 congenital laryngomalacia

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For questions please contact: [email protected]

Health Care Quality and Outcomes (HCQO)

2018-19 Indicator definitions

NOVEMBER 2018

Contents

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INDICATOR DEFINITONS

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PRIMARY CARE - AVOIDABLE HOSPITAL ADMISSION (AA) INDICATORS

Indicators in the Avoidable admission indicator set include:

1. Asthma hospital admission

2. Chronic obstructive pulmonary disease (COPD) hospital admission

3. Congestive heart failure (CHF) hospital admission

4. Hypertension hospital admission

5. Diabetes hospital admission

6. Diabetes lower extremity amputation using unlinked data

7. Diabetes lower extremity amputation using linked data

AA

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AA1) ASTHMA HOSPITAL ADMISSION (See Glossary for definitions of italicized terminology)

Asthma diagnosis codes:

ICD-9-CM ICD-10-WHO

49300 EXTRINSIC ASTHMA NOS J450 PREDOMINANTLY ALLERGIC ASTHMA

49301 EXT ASTHMA W STATUS ASH J451 NONALLERGIC ASTHMA

49302 EXT ASTHMA W ACUTE EXAC J458 MIXED ASTHMA

49310 INT ASTHMA W/O STAT ASTH J459 ASTHMA, UNSPECIFIED

49311 INTRINSIC ASTHMA NOS J46 STATUS ASTHMATICUS

49312 INT ASTHMA W ACUTE EXAC

49320 CH OB ASTH NOS

49321 CH OB ASTHMA W STAT ASTH

49322 CH OBS ASTH W ACUTE EXAC

49381 EXERCSE IND BRONCHOSPASM

49382 COUGH VARIANT ASTHMA

49390 ASTHMA NOS

49391 ASTHMA W STATUS ASTHMAT

49392 ASTHMA W ACUTE EXAC

AA

Coverage: Population aged 15 and older (5 year age groups). All acute care hospitals, including public and

private hospitals that provide inpatient care.

Numerator: All non-maternal/non-neonatal hospital admissions with a principal diagnosis code of asthma

(see Asthma diagnosis codes below) in a specified year.

Exclude:

Cases where the patient died in hospital during the admission.

Cases resulting from a transfer from another acute care institution (transfers-in).

Cases with MDC 14 or specified pregnancy, childbirth, and puerperium codes in any field – Refer

to Annex D (Excel sheet - HCQO 2018_19 Data Collection_Annex A-I)

Cases with cystic fibrosis and anomalies of the respiratory system diagnosis code in any field (see

ICD codes below)

Cases that are same day/day only admissions

Denominator: Population count.

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Exclude diagnosis codes cystic fibrosis and anomalies of the respiratory system:

ICD-9-CM ICD-10-WHO

27700 CYSTIC FIBROS W/O ILEUS

27701 CYSTIC FIBROS W ILEUS

27702 CYSTIC FIBROS W PUL MAN

27703 CYSTIC FIBROSIS W GI MAN

27709 CYSTIC FIBROSIS NEC

74721 ANOMALIES OF AORTIC ARCH

7483 LARYNGOTRACH ANOMALY NEC

7484 CONGENITAL CYSTIC LUNG

7485 AGENESIS OF LUNG

74860 LUNG ANOMALY NOS

74861 CONGEN BRONCHIECTASIS

74869 LUNG ANOMALY NEC

7488 RESPIRATORY ANOMALY NEC

7489 RESPIRATORY ANOMALY NOS

7503 CONG ESOPH FISTULA/ATRES

7593 SITUS INVERSUS

7707 PERINATAL CHR RESP DIS

E840 CYSTIC FIBROSIS WITH PULMONARY MANIFESTATIONS

E841 CYSTIC FIBROSIS WITH INTESTINAL MANIFESTATIONS

E848 CYSTIC FIBROSIS WITH OTHER MANIFESTATIONS

E849 CYSTIC FIBROSIS, UNSPECIFIED

P27.0 WILSON-MIKITY SYNDROME

P27.1 BRONCHOPULMONARY DYSPLASIA ORIGINATING IN

THE PERINATAL PERIOD

P27.8 OTHER CHRONIC RESPIRATORY DISEASES ORIGINATING

IN THE PERINATAL PERIOD

P27.9 UNSPECIFIED CHRONIC RESP DISEASE ORIGINATING IN

THE PERINATAL PERIOD

Q25.4 OTHER CONGENITAL MALFORMATIONS OF AORTA

Q31.1 CONGENITAL SUBGLOTTIC STENOSIS

Q31.2 LARYNGEAL HYPOPLASIA

Q31.3 LARYNGOCELE

Q31.5 CONGENITAL LARYNGOMALACIA

Q31.8 OTHER CONGENITAL MALFORMATIONS OF LARYNX

Q31.9 CONGENITAL MALFORMATION OF LARYNX,

UNSPECIFIED

Q32.0 CONGENITAL TRACHEOMALACIA

Q32.1 OTHER CONGENITAL MALFORMATIONS OF TRACHEA

Q32.2 CONGENITAL BRONCHOMALACIA

Q32.3 CONGENITAL STENOSIS OF BRONCHUS

Q32.4 OTHER CONGENITAL MALFORMATIONS OF BRONCHUS

Q33.0 CONGENITAL CYSTIC LUNG

Q33.1 ACCESSORY LOBE OF LUNG

Q33.2 SEQUESTRATION OF LUNG

Q33.3 AGENESIS OF LUNG

Q33.4 CONGENITAL BRONCHIECTASIS

Q33.5 ECTOPIC TISSUE IN LUNG

Q33.6 HYPOPLASIA AND DYSPLASIA OF LUNG

Q33.8 OTHER CONGENITAL MALFORMATIONS OF LUNG

Q33.9 CONGENITAL MALFORMATION OF LUNG, UNSPECIFIED

Q34.0 ANOMALY OF PLEURA

Q34.1 CONGENITAL CYST OF MEDIASTINUM

Q34.8 OTHER SPECIFIED CONGENITAL MALFORMATIONS OF

RESPIRATORY SYSTEM

Q34.9 CONGENITAL MALFORMATION OF RESPIRATORY

SYSTEM, UNSPECIFIED

Q39.0 ATRESIA OF OESOPHAGUS WITHOUT FISTULA

Q39.1 ATRESIA OF OESOPHAGUS WITH TRACHEO-

OESOPHAGEAL FISTULA

Q39.2 CONGENITAL TRACHEO-OESOPHAGEAL FISTULA

WITHOUT ATRESIA

Q39.3 CONGENITAL STENOSIS AND STRICTURE OF

OESOPHAGUS

Q39.4 OESOPHAGEAL WEB

Q39.8 OTHER CONGENITAL MALFORMATIONS OF

OESOPHAGUS

Q89.3 SITUS INVERSUS

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AA2) CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) HOSPITAL

ADMISSION (See Glossary for definitions of italicized terminology)

COPD diagnosis codes:

ICD-9-CM ICD-10-WHO

490 BRONCHITIS NOS* 4660 AC BRONCHITIS* 4910 SIMPLE CHR BRONCHITIS

4911 MUCOPURUL CHR BRONCHITIS

49120 OBS CHR BRNC W/O ACT EXA

49121 OBS CHR BRNC W ACT EXA

4918 CHRONIC BRONCHITIS NEC

4919 CHRONIC BRONCHITIS NOS

4920 EMPHYSEMATOUS BLEB

4928 EMPHYSEMA NEC

494 BRONCHIECTASIS

4940 BRONCHIECTAS W/O AC EXAC

4941 BRONCHIECTASIS W AC EXAC

496 CHR AIRWAY OBSTRUCT NEC

* Qualifies only if accompanied by secondary

diagnosis of 491.xx, 492.x, 494.x or 496 (i.e.,

any other code on this list).

J40 BRONCHITIS*

J410 SIMPLE CHRONIC BRONCHITIS

J411 MUCOPURULENT CHRONIC BRONCHITIS

J418 MIXED SIMPLE AND MUCOPURULENT CHRONIC BRONCHITIS

J42 UNSPECIFIED CHRONIC BRONCHITIS

J430 MACLEOD'S SYNDROME

J431 PANLOBULAR EMPHYSEMA

J432 CENTRILOBULAR EMPHYSEMA

J438 OTHER EMPHYSEMA

J439 EMPHYSEMA, UNSPECIFIED

J440 COPD WITH ACUTE LOWER RESPIRATORY INFECTION

J441 COPD WITH ACUTE EXACERBATION, UNSPECIFIED

J448 OTHER SPECIFIED CHRONIC OBSTRUCTIVE PULMONARY

DISEASE

J449 CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED

J47 BRONCHIECTASIS

* Qualifies only if accompanied by secondary diagnosis of J41, J43, J44, J47



Numerator: All non-maternal/non-neonatal hospital admissions with a principal diagnosis code of Chronic

Obstructive Pulmonary Disease (See COPD diagnosis codes below) in a specified year.

Exclude:







AA

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AA3) CONGESTIVE HEART FAILURE (CHF) HOSPITAL ADMISSION (See Glossary for definitions of italicized terminology)

CHF diagnosis codes:

ICD-9-CM ICD-10-WHO

39891 RHEUMATIC HEART FAILURE

40201 MAL HYPERT HRT DIS W CHF

40211 BENIGN HYP HRT DIS W CHF

40291 HYPERTEN HEART DIS W CHF

40401 MAL HYPER HRT/REN W CHF

40403 MAL HYP HRT/REN W CHF/RF

40411 BEN HYPER HRT/REN W CHF

40413 BEN HYP HRT/REN W CHF/RF

40491 HYPER HRT/REN NOS W CHF

40493 HYP HT/REN NOS W CHF/RF

4280 CONGESTIVE HEART FAILURE

4281 LEFT HEART FAILURE

42820 SYSTOLIC HRT FAILURE NOS

42821 AC SYSTOLIC HRT FAILURE

42822 CHR SYSTOLIC HRT FAILURE

42823 AC ON CHR SYST HRT FAIL

42830 DIASTOLC HRT FAILURE NOS

42831 AC DIASTOLIC HRT FAILURE

42832 CHR DIASTOLIC HRT FAIL

I11.0 HYPERTENSIVE HEART DISEASE WITH

(CONGESTIVE) HEART FAILURE

I13.0 HYPERTENSIVE HEART AND RENAL

DISEASE WITH (CONGESTIVE) HEART FAILURE

I13.2 HYPERTENSIVE HEART AND RENAL

DISEASE WITH BOTH (CONGESTIVE) HEART

FAILURE AND RENAL FAILURE

I50.0 CONGESTIVE HEART FAILURE

I50.1 LEFT VENTRICULAR FAILURE

I50.9 HEART FAILURE, UNSPECIFIED



Numerator: All non-maternal/non-neonatal hospital admissions with principal diagnosis code of Congestive

Heart Failure (See CHF diagnosis codes below) in a specified year.

Exclude:



Cases with cardiac procedure codes in any field – Refer to Annex A (Excel sheet - HCQO 2018_19

Data Collection_Annex A-I)





AA

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42833 AC ON CHR DIAST HRT FAIL

42840 SYST/DIAST HRT FAIL NOS

42841 AC SYST/DIASTOL HRT FAIL

42842 CHR SYST/DIASTL HRT FAIL

42843 AC/CHR SYST/DIA HRT FAIL

4289 HEART FAILURE NOS

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AA4) HYPERTENSION HOSPITAL ADMISSION (See Glossary for definitions of italicized terminology)

Hypertension diagnosis codes:

ICD-9-CM ICD-10-WHO

4010 MALIGNANT HYPERTENSION

4019 HYPERTENSION NOS

40200 MAL HYPERTEN HRT DIS NOS

40210 BEN HYPERTEN HRT DIS NOS

40290 HYPERTENSIVE HRT DIS NOS

40300 MAL HYP REN W/O REN FAIL

40310 BEN HYP REN W/O REN FAIL

40390 HYP REN NOS W/O REN FAIL

40400 MAL HY HT/REN W/O CHF/RF

40410 BEN HY HT/REN W/O CHF/RF

40490 HY HT/REN NOS W/O CHF/RF

I10 ESSENTIAL (PRIMARY) HYPERTENSION

I119 HYPERTENSIVE HEART DISEASE WITHOUT

(CONGESTIVE) HEART FAILURE

I129 HYPERTENSIVE RENAL DISEASE WITHOUT

RENAL FAILURE

I139 HYPERTENSIVE HEART AND RENAL

DISEASE, UNSPECIFIED



Numerator: All non-maternal/non-neonatal hospital admissions with principal diagnosis code of

Hypertension (see Hypertension diagnosis codes below) in a specified year.

Exclude:



Cases with cardiac procedure codes in any field – Refer to Annex A (Excel sheet - HCQO 2018_19

Data Collection_Annex A-I)





AA

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AA5) DIABETES HOSPITAL ADMISSION (See Glossary for definitions of italicized terminology)

Diabetes diagnosis codes

ICD-9-CM ICD-10-WHO

25002 DMII WO CMP UNCNTRLD

25003 DMI WO CMP UNCNTRLD

25010 DMII KETO NT ST UNCNTRLD

25011 DMI KETO NT ST UNCNTRLD

25012 DMII KETOACD UNCONTROLD

25013 DMI KETOACD UNCONTROLD

25020 DMII HPRSM NT ST UNCNTRL

25021 DMI HPRSM NT ST UNCNTRLD

25022 DMII HPROSMLR UNCONTROLD

25023 DMI HPROSMLR UNCONTROLD

25030 DMII O CM NT ST UNCNTRLD

25031 DMI O CM NT ST UNCNTRL

25032 DMII OTH COMA UNCONTROLD

25033 DMI OTH COMA UNCONTROLD

25040 DMII RENL NT ST UNCNTRLD

25041 DMI RENL NT ST UNCNTRLD

25042 DMII RENAL UNCNTRLD

25043 DMI RENAL UNCNTRLD

25050 DMII OPHTH NT ST UNCNTRL

25051 DMI OPHTH NT ST UNCNTRLD

25052 DMII OPHTH UNCNTRLD

25053 DMI OPHTH UNCNTRLD

25060 DMII NEURO NT ST UNCNTRL

25061 DMI NEURO NT ST UNCNTRLD

E10.0 INSULIN-DEPENDENT DIABETES MELLITUS WITH

COMA


KETOACIDOSIS


RENAL COMPLICATIONS


OPHTHALMIC COMPLICATIONS


NEUROLOGICAL COMPLICATIONS

E10.5 INSULIN-DEPENDENT DM WITH PERIPHERAL

CIRCULATORY COMPLICATIONS

E10.6 INSULIN-DEPENDENT DM WITH OTHER SPECIFIED

COMPLICATIONS


MULTIPLE COMPLICATIONS


UNSPECIFIED COMPLICATIONS

E10.9 INSULIN-DEPENDENT DIABETES MELLITUS

WITHOUT COMPLICATIONS

E11.0 NON-INSULIN-DEPENDENT DIABETES MELLITUS

WITH COMA


WITH KETOACIDOSIS



Numerator: All non-maternal/non-neonatal hospital admissions with a principal diagnosis code of diabetes

(see Diabetes diagnosis codes below) in a specified year.

Exclude:







AA

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25062 DMII NEURO UNCNTRLD

25063 DMI NEURO UNCNTRLD

25070 DMII CIRC NT ST UNCNTRLD

25071 DMI CIRC NT ST UNCNTRLD

25072 DMII CIRC UNCNTRLD

25073 DMI CIRC UNCNTRLD

25080 DMII OTH NT ST UNCNTRLD

25081 DMI OTH NT ST UNCNTRLD

25082 DMII OTH UNCNTRLD

25083 DMI OTH UNCNTRLD

25090 DMII UNSPF NT ST UNCNTRL

25091 DMI UNSPF NT ST UNCNTRLD

25092 DMII UNSPF UNCNTRLD

25093 DMI UNSPF UNCNTRLD


WITH RENAL COMPLICATIONS

E11.3 NON-INSULIN-DEPENDENT DMWITH OPHTHALMIC

COMPLICATIONS

E11.4 NON-INSULIN-DEPENDENT DM WITH


E11.5 NON-INSULIN-DEPENDENT DM WITH PERIPHERAL


E11.6 NON-INSULIN-DEPENDENT DM WITH OTHER

SPECIFIED COMPLICATIONS


WITH MULTIPLE COMPLICATIONS

E11.8 NON-INSULIN-DEPENDENT DM WITH UNSPECIFIED

COMPLICATIONS



E13.0 OTHER SPECIFIED DIABETES MELLITUS WITH COMA

E13.1 OTHER SPECIFIED DIABETES MELLITUS WITH

KETOACIDOSIS


RENAL COMPLICATIONS





E13.5 OTHER SPECIFIED DM WITH PERIPHERAL



OTHER SPECIFIED COMPLICATIONS





E13.9 OTHER SPECIFIED DIABETES MELLITUS WITHOUT

COMPLICATIONS

E14.0 UNSPECIFIED DIABETES MELLITUS WITH COMA

E14.1 UNSPECIFIED DIABETES MELLITUS WITH

KETOACIDOSIS

E14.2 UNSPECIFIED DIABETES MELLITUS WITH RENAL

COMPLICATIONS





E14.5 UNSPECIFIED DM WITH PERIPHERAL CIRCULATORY

COMPLICATIONS

E14.6 UNSPECIFIED DIABETES MELLITUS WITH OTHER


E14.7 UNSPECIFIED DIABETES MELLITUS WITH MULTIPLE

COMPLICATIONS



E14.9 UNSPECIFIED DIABETES MELLITUS WITHOUT

COMPLICATIONS

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AA6) DIABETES LOWER EXTREMITY AMPUTATION USING UNLINKED DATA (See Glossary for definitions of italicized terminology)

Coverage: Population aged 15 and older. All acute care hospitals, including public and private hospitals that

provide inpatient care.

Numerator: All non-maternal/non-neonatal admissions with a procedure code of major lower extremity

amputation in any field and a diagnosis code of diabetes in any field (see Diabetes major lower extremity

amputation and diabetes diagnosis codes below) in a specified year.

Exclude:




Cases with trauma diagnosis code (see Trauma diagnosis codes below) in any field

Cases with tumour-related peripheral amputation code (ICD-9-CM 1707 and 1708/ICD-10-WHO

C40.2 and C40.3) in any field


Denominator 1: Population count.

Denominator 2: Estimated population with diabetes

Countries are requested to provide the diabetes prevalence (%) estimates for each age cohort. It is recognised

that countries may not have prevalence estimates for the specified age cohorts, in which case, countries may

apply the average or a linear estimate across the cohorts.

The population with diabetes will be calculated by applying the estimated proportion (%) of the general

population in each age cohort that has diabetes.

AA

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Diabetes major lower extremity amputation and diabetes diagnosis codes:

ICD-9-CM ICD-10-WHO

Procedure codes for major lower-extremity

amputation

8413 DISARTICULATION OF ANKLE

8414 AMPUTAT THROUGH MALLEOLI

8415 BELOW KNEE AMPUTAT NEC

8416 DISARTICULATION OF KNEE

8417 ABOVE KNEE AMPUTATION

8418 DISARTICULATION OF HIP

8419 HINDQUARTER AMPUTATION

Diagnosis Codes For Diabetes:

25000 DMII WO CMP NT ST UNCNTR

25001 DMI WO CMP NT ST UNCNTRL








































amputation

NOT SPECIFIED

Diagnosis codes for diabetes:


WITH COMA


WITH KETOACIDOSIS




WITH OPHTHALMIC COMPLICATIONS


WITH NEUROLOGICAL COMPLICATIONS

E10.5 INSULIN-DEPENDENT DM WITH

PERIPHERAL CIRCULATORY COMPLICATIONS

E10.6 INSULIN-DEPENDENT DM WITH OTHER





WITH UNSPECIFIED COMPLICATIONS



E11.0 NON-INSULIN-DEPENDENT DIABETES

MELLITUS WITH COMA


MELLITUS WITH KETOACIDOSIS


MELLITUS WITH RENAL COMPLICATIONS

E11.3 NON-INSULIN-DEPENDENT DMWITH









MELLITUS WITH MULTIPLE COMPLICATIONS




MELLITUS WITHOUT COMPLICATIONS

E13.0 OTHER SPECIFIED DIABETES MELLITUS

WITH COMA

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WITH KETOACIDOSIS










WITH OTHER SPECIFIED COMPLICATIONS








COMA


KETOACIDOSIS


RENAL COMPLICATIONS





E14.5 UNSPECIFIED DM WITH PERIPHERAL








E14.9 UNSPECIFIED DIABETES MELLITUS


Exclude trauma diagnosis codes:

ICD-9-CM ICD-10-WHO

8950 AMPUTATION TOE

8951 AMPUTATION TOE-COMPLICAT

8960 AMPUTATION FOOT, UNILAT

8961 AMPUT FOOT, UNILAT-COMPL

8962 AMPUTATION FOOT, BILAT

8963 AMPUTAT FOOT, BILAT-COMP

8970 AMPUT BELOW KNEE, UNILAT

8971 AMPUTAT BK, UNILAT-COMPL

8972 AMPUT ABOVE KNEE, UNILAT

8973 AMPUT ABV KN, UNIL-COMPL

8974 AMPUTAT LEG, UNILAT NOS

8975 AMPUT LEG, UNIL NOS-COMP

8976 AMPUTATION LEG, BILAT

8977 AMPUTAT LEG, BILAT-COMPL

S78.0 TRAUMATIC AMPUTATION AT HIP JOINT

S78.1 TRAUMATIC AMPUTATION AT LEVEL

BETWEEN HIP AND KNEE

S78.9 TRAUMATIC AMPUTATION OF HIP AND THIGH,

LEVEL UNSPECIFIED

S88.0 TRAUMATIC AMPUTATION AT KNEE LEVEL


BETWEEN KNEE AND ANKLE

S88.9 TRAUMATIC AMPUTATION OF LOWER LEG,

LEVEL UNSPECIFIED

S98.0 TRAUMATIC AMPUTATION OF FOOT AT ANKLE

LEVEL

S98.1 TRAUMATIC AMPUTATION OF ONE TOE

S98.2 TRAUMATIC AMPUTATION OF TWO OR MORE

TOES

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S98.3 TRAUMATIC AMPUTATION OF OTHER PARTS

OF FOOT

S98.4 TRAUMATIC AMPUTATION OF FOOT, LEVEL

UNSPECIFIED

T05.3 TRAUMATIC AMPUTATION OF BOTH FEET

T05.4 TRAUMATIC AMPUTATION OF 1 FOOT AND

OTHER LEG [ANY LEVEL, EXCEPT FOOT]

T05.5 TRAUMATIC AMPUTATION OF BOTH LEGS

[ANY LEVEL]

T13.6 TRAUMATIC AMPUTATION OF LOWER LIMB,

LEVEL UNSPECIFIED

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AA7) DIABETES LOWER EXTREMITY AMPUTATION USING LINKED DATA (See Glossary for definitions of italicized terminology)

Coverage: Population aged 15 and older. All acute care hospitals, including public and private hospitals that

provide inpatient care.

Numerator: All diabetic patients admitted for a major lower extremity amputation (see Diabetes major lower

extremity amputation codes below) in the specified year.

Counting Rules

Only one major lower extremity amputation admission is to be counted for each diabetic patient in the

specified year. The admission with the most severe amputation is to be selected if more than one admission

is identified for a diabetic patient in the specified year.

Diabetic patients are to be identified by using a unique person identifier (UPI). For all patients with an

amputation in the specified year, the aim is to search for:

First, diabetes codes in any field in the hospital administrative dataset (see diabetes diagnosis codes

below) for up to 5 years, including the specified year and prior years where the UPI can be reliably

and consistently used, and then

Second, records indicating diabetes status in any other relevant database (e.g. pharmaceutical,

specialist, laboratory data) where the UPI can be reliably and consistently used to identify additional

patients.

Exclude:

Cases with Pregnancy, childbirth, and puerperium codes in any field – Refer to Annex D (Excel

sheet - HCQO 2018_19 Data Collection_Annex A-I)

Cases with trauma diagnosis code (see Trauma diagnosis codes below) in any field

Cases with tumour-related peripheral amputation code (ICD-9-CM 1707 and 1708/ICD-10-WHO

C40.2 and C40.3) in any field

Denominator 1: Population count.

Denominator 2: Estimated population with diabetes

Countries are requested to provide the diabetes prevalence (%) estimates for each age cohort. It is recognised

that countries may not have prevalence estimates for the specified age cohorts, in which case, countries may

apply the average or a linear estimate across the cohorts.

The population with diabetes will be calculated by applying the estimated proportion (%) of the general

population in each age cohort that has diabetes.

AA

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Diabetes major lower extremity amputation and diabetes diagnosis codes:

ICD-9-CM ICD-10-WHO


amputation

8413 DISARTICULATION OF ANKLE

8414 AMPUTAT THROUGH MALLEOLI

8415 BELOW KNEE AMPUTAT NEC

8416 DISARTICULATION OF KNEE

8417 ABOVE KNEE AMPUTATION

8418 DISARTICULATION OF HIP

8419 HINDQUARTER AMPUTATION

Diagnosis Codes For Diabetes:

25000 DMII WO CMP NT ST UNCNTR

25001 DMI WO CMP NT ST UNCNTRL








































amputation

NOT SPECIFIED

Diagnosis codes for diabetes:


WITH COMA


WITH KETOACIDOSIS







E10.5 INSULIN-DEPENDENT DM WITH


E10.6 INSULIN-DEPENDENT DM WITH OTHER









MELLITUS WITH COMA


MELLITUS WITH KETOACIDOSIS


MELLITUS WITH RENAL COMPLICATIONS

E11.3 NON-INSULIN-DEPENDENT DMWITH









MELLITUS WITH MULTIPLE COMPLICATIONS




MELLITUS WITHOUT COMPLICATIONS


WITH COMA

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WITH KETOACIDOSIS










WITH OTHER SPECIFIED COMPLICATIONS








COMA


KETOACIDOSIS


RENAL COMPLICATIONS





E14.5 UNSPECIFIED DM WITH PERIPHERAL








E14.9 UNSPECIFIED DIABETES MELLITUS


Exclude trauma diagnosis codes:

ICD-9-CM ICD-10-WHO

8950 AMPUTATION TOE

8951 AMPUTATION TOE-COMPLICAT

8960 AMPUTATION FOOT, UNILAT

8961 AMPUT FOOT, UNILAT-COMPL

8962 AMPUTATION FOOT, BILAT

8963 AMPUTAT FOOT, BILAT-COMP

8970 AMPUT BELOW KNEE, UNILAT

8971 AMPUTAT BK, UNILAT-COMPL

8972 AMPUT ABOVE KNEE, UNILAT

8973 AMPUT ABV KN, UNIL-COMPL

8974 AMPUTAT LEG, UNILAT NOS

8975 AMPUT LEG, UNIL NOS-COMP

8976 AMPUTATION LEG, BILAT

8977 AMPUTAT LEG, BILAT-COMPL

S78.0 TRAUMATIC AMPUTATION AT HIP JOINT


BETWEEN HIP AND KNEE

S78.9 TRAUMATIC AMPUTATION OF HIP AND THIGH,

LEVEL UNSPECIFIED

S88.0 TRAUMATIC AMPUTATION AT KNEE LEVEL


BETWEEN KNEE AND ANKLE

S88.9 TRAUMATIC AMPUTATION OF LOWER LEG,

LEVEL UNSPECIFIED

S98.0 TRAUMATIC AMPUTATION OF FOOT AT ANKLE

LEVEL

S98.1 TRAUMATIC AMPUTATION OF ONE TOE

S98.2 TRAUMATIC AMPUTATION OF TWO OR MORE

TOES

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S98.3 TRAUMATIC AMPUTATION OF OTHER PARTS

OF FOOT

S98.4 TRAUMATIC AMPUTATION OF FOOT, LEVEL

UNSPECIFIED

T05.3 TRAUMATIC AMPUTATION OF BOTH FEET

T05.4 TRAUMATIC AMPUTATION OF 1 FOOT AND

OTHER LEG [ANY LEVEL, EXCEPT FOOT]

T05.5 TRAUMATIC AMPUTATION OF BOTH LEGS

[ANY LEVEL]

T13.6 TRAUMATIC AMPUTATION OF LOWER LIMB,

LEVEL UNSPECIFIED

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PRIMARY CARE - PRESCRIBING (PR) INDICATORS

Indicators in the Prescribing indicator set include:

1. Adequate use of cholesterol lowering treatment in people with diabetes

2. First choice antihypertensives for people with diabetes

3. Long-term use of benzodiazepines and benzodiazepine related drugs in 65 years and over

4. Use of long-acting benzodiazepines in older people in 65 years and over

5. Volume of cephalosporines and quinolones as a proportion of all systemic antibiotics prescribed

6. Overall volume of antibiotics for systemic use prescribed

7. Any anticoagulating drug in combination with an oral NSAID

8. Proportion of 75 years and over who are taking more than 5 medications concurrently

9. Overall volume of opioids prescribed

10. Proportion of the population who are chronic opioid users

11. Proportion of 65 years and over prescribed antipsychotics

NOTES

Data are requested for prescribing undertaken in PRIMARY CARE ONLY. Please exclude, as far as

possible, prescribing undertaken in specialist secondary care. Please specify on the Sources and Methods

survey the health care sectors to which the data pertain.

Countries are requested to provide data only for the latest year available, preferably 2017 or nearest

year. The preferred data are those based on DDDs but if not please provide data based on days.

Skip the worksheets for which you are not able to provide data for the numerator and / or denominator of

the indicator.

Please refer to the following guidelines for DDD and ATC codes

WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD

assignment 2018. Oslo, Norway, 2017. https://www.whocc.no/filearchive/publications/guidelines.pdf

PR

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PR1) ADEQUATE USE OF CHOLESTEROL LOWERING TREATMENT IN PEOPLE WITH

DIABETES

(See Glossary for definitions of italicized terminology)

Coverage: Population in the prescribing database

Numerator: Number of people who are long-term users of glucose regulating medication (A10B) with

concomitant use of ≥ 1 prescription of cholesterol lowering medication (C10).

Denominator: Number of people who are long-term users of glucose regulating medication (A10B) in the

database

Notes: Number of people who are long-term users of glucose regulating medication (A10B) are defined as

individuals who use >270 Defined Daily Doses (DDD) of A10B per year. If your database does not report

DDD, please derive indicator using >270 days of A10B per year.

PR

22


PR2) FIRST CHOICE ANTIHYPERTENSIVES FOR PEOPLE WITH DIABETES


Coverage: Population in prescribing database

Numerator: Number of people who are long-term users of glucose regulating medication (A10B) with

concomitant use of ≥ 1 prescription angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor

blocker (ARB) (C09, C10BX04, C10BX06, C10BX07, C10BX10, C10BX11, C10BX12, C10BX13,

C10BX14, C10BX15).

Denominator: Number of people who are long-term users of glucose regulating medication (A10B) with

concomitant use of ≥ 1 prescription antihypertensives (ATC-C02) or diuretics (ATC C03) or beta-blockers

(ATC C07) or calcium channel blockers (C08) or angiotensin converting enzyme inhibitor (ACE-I) or

angiotensin receptor blocker (ARB) (C09) or C10BX03 or C10BX04, or C10BX06, or C10BX07, or

C10BX09, or C10BX10 or C10BX11or C10BX12 or C10BX13 or C10BX14 or C10BX15

Notes: Number of people who are long-term users of glucose regulating medication (A10B) are defined as

individuals who use >270 Defined Daily Doses (DDD) of A10B per year. If your database does not report

DDD, please derive indicator using >270 days of A10B per year.

PR

23


PR3) LONG-TERM USE OF BENZODIAZEPINES AND BENZODIAZEPINE RELATED DRUGS

IN ≥ 65 YEARS OF AGE ( > 365 DDD IN ONE YEAR)


Coverage: Population aged 65 years and over in prescribing database

Numerator: Number of individuals ≥ 65 years of age at 1 January in database with > 365 DDDs of

benzodiazepines (N05BA or N05CD or N05CF or N03AE01) prescribed in the year.

Denominator: Number of individuals ≥ 65 years of age at 1 January in database

Note: If your database does not report DDD, please derive indicator using > 365 days of benzodiazepines per

year.

PR

24


PR4) USE OF LONG-ACTING BENZODIAZEPINES IN ≥ 65 YEARS OF AGE



Numerator: Number of individuals ≥ 65 years of age at 1 January in database with ≥ 1 prescription long-

acting benzodiazepines (N05BA01, N05BA02, N05BA05, N05BA08, N05BA11, N05CD01, N05CD02,

N05CD03, N05CD10)


PR

25


PR5) VOLUME OF CEPHALOSPORINES AND QUINOLONES AS A PROPORTION OF ALL

SYSTEMIC ANTIBIOTICS PRESCRIBED (DDD)



Numerator: Sum DDDs of all ATC J01D and J01M prescriptions.

Denominator: Sum DDDs of all ATC J01 prescriptions in database

PR

26


PR6) OVERALL VOLUME OF ANTIBIOTICS FOR SYSTEMIC USE PRESCRIBED (DDD)



Numerator: Sum DDD of all ATC J01 prescriptions

Denominator: Population covered by database at 1 January.

PR

27


PR7) ANY ANTICOAGULATING DRUG (ACENOCOUMAROL, WARFARIN,

PHRENPROCOUMON, DABIGATRAN, RIVAROXABAN OR APIXABAN) IN COMBINATION

WITH AN ORAL NSAID



Numerator: Number of individuals who are long-term users of anticoagulating drugs acenocoumarol

(B01AA07) or warfarin (B01AA03) or phenprocoumon (B01AA04) or dabigatran (B01AE07) or

rivaroxaban (B01AF01) or apixaban (B01AF02) with concomitant use of ≥ 1 prescription of NSAID (M01A

or M01B)

Denominator: Number of individuals who long-term users of ATC-codes acenocoumarol (B01AA07) or

warfarin (B01AA03) or phenprocoumon (B01AA04) or dabigatran (B01AE07) or rivaroxaban (B01AF01)

or apixaban (B01AF02)

Note: individuals who are long-term users of anticoagulating drugs are defined as individuals who use >270

Defined Daily Doses (DDD) of the B01A codes listed above. If your database does not report DDD, please

derive indicator using >270 days of the B01A codes listed above.

PR

28


PR8) PROPORTION OF 75 YEARS AND OVER WHO ARE TAKING MORE THAN 5

MEDICATIONS CONCURRENTLY (>90 DAYS EXCLUDING DERMATOLOGICAL AND

ANTIBIOTICS)



Numerator: Number of individuals ≥ 75 years of age as at 1 January in database with ≥ 5 chronically used

medications with different ATC codes at the fourth level (e.g., A10BA) during the year.

Chronic usage is defined as medication prescribed for more than 90 days or four or more prescriptions of a

medication in the year. A medication can be within a similar ATC codes at the fourth level.


NOTE: Dermatologicals for topical usage are excluded of the count because these medications usually do not

interact with other (systemic) medications. Antibiotics (i.e., ATC codes “J01”) are also excluded because

they are almost exclusively prescribed for acute infections.

Medication here refers to subgroups of chemicals classified by the World Health Organization at the fourth

level of the ATC classification system, 2017 version.

PR

29


PR9) OVERALL VOLUME OF OPIOIDS PRESCRIBED (DDDs PER 1000 POPULATION PER

DAY)



Numerator: Sum DDD of all ATC N02A prescriptions

Denominator: Number of individuals ≥ 18 years of age at 1 January 2017 in database

NOTE:

Methadone and buprenorphine/naloxonecombinations (Suboxone) are excluded from all analyses, as these

products are most often used in the treatment of addiction and the focus of this collection is opioids for

pain.

PR

30


PR10) PROPORTION OF THE POPULATION WHO ARE CHRONIC OPIOID USERS (≥ 90

DAY’S SUPPLY IN A YEAR) (See Glossary for definitions of italicized terminology)


Numerator: Number of individuals ≥ 18 years of age at 1 January in database with 2 or more prescriptions

of opioids (N02A) prescribed for ≥ 90 days in the year.

Denominator: Number of individuals ≥ 18 years of age at 1 January 2017 in database

NOTE:

Methadone and buprenorphine/naloxonecombinations (Suboxone) are excluded from all analyses, as these

products are most often used in the treatment of addiction and the focus of this collection is opioids for

pain.

PR

31


PR11) PROPORTION OF PEOPLE 65 YEARS AND OVER PRESCRIBED ANTIPSYCHOTICS (See Glossary for definitions of italicized terminology)

Coverage: All persons 65 years and over (on the first day of the reference year) in the prescribing database

(5 year age groups)

Numerator: Number of individuals ≥65 years on first day of reference year with ≥1 prescription for any

antipsychotic medication (ATC codes N05A) prescribed during the reference year.

Denominator: Number of individuals ≥65 years of age on first day of reference year in the national

prescription database in the reference year.

Exclude:

Prescriptions for antipsychotic medications registered through in-patient hospital prescription

registries.

PR

32


ACUTE CARE (AC) INDICATORS

Indicators in the acute care indicator set include:

1. AMI 30 day mortality - National level using linked data

2. AMI 30 day mortality - National level - Age, sex, co-morbidity, previous AMI adjusted using linked

data

3. AMI 30 day mortality - Hospital level using linked data

4. AMI 30 day mortality - National level using unlinked data

5. AMI 30 day mortality - National level - Age sex, co-morbidity adjusted using unlinked data

6. AMI 30 day mortality - Hospital level using unlinked data

7. Hemorrhagic stroke 30 day mortality - National level using linked data

8. Hemorrhagic stroke 30 day mortality - National level - Age, sex, co-morbidity, previous AMI

adjusted using linked data

9. Hemorrhagic stroke 30-day mortality - Hospital level using linked data

10. Hemorrhagic stroke 30 day mortality - National level using unlinked data

11. Hemorrhagic stroke 30 day mortality - National level - Age sex, co-morbidity adjusted using

unlinked data

12. Hemorrhagic stroke 30 day mortality - Hospital level using unlinked data

13. Ischemic stroke 30 day mortality - National level using linked data

14. Ischemic stroke 30 day mortality - National level - Age, sex, co-morbidity, previous AMI adjusted

using linked data

15. Ischemic stroke 30-day mortality - Hospital level using linked data

16. Ischemic stroke 30 day mortality - National level using unlinked data

17. Ischemic stroke 30 day mortality - National level - Age sex, co-morbidity adjusted using unlinked

data

18. Ischemic stroke 30 day mortality - Hospital level using unlinked data

19. Hip fracture surgery initiated within 2 calendar days after admission to the hospital

AC

33


AC1) AMI 30 DAY MORTALITY - NATIONAL LEVEL USING LINKED DATA


Coverage: Patients aged 15 and older (5 year age group)

Numerator: Number of deaths in any hospital and out of hospital that occurred within 30 days of the

admission date of the denominator cases.

Denominator: The last admission for each patient admitted to hospital for acute non-elective (urgent) care

with a principal diagnosis (PDx) of acute myocardial infarction during 1 January to 31 December in the

specified year. [AMI diagnostic codes upon separation: ICD-9 410 or ICD-10 I21, I22.].

Please note only one admission per patient is to be counted in the denominator and the numerator is calculated

by following up all denominator cases for up to 30 days.

AC

34


AC2) AMI 30 DAY MORTALITY - NATIONAL LEVEL - AGE, SEX, CO-MORBIDITY,

PREVIOUS AMI ADJUSTED USING LINKED DATA

NOTE:

No calculation information is available for this indicator in the data collection guidelines. This indicator

should be calculated only using SAS code provided by the OECD as part of Method II. Please see Table 4

for relevant SAS programs.

AC

35


AC3) AMI 30-DAY MORTALITY - HOSPITAL LEVEL USING LINKED DATA

NOTE:




AC

36


AC4) AMI 30 DAY MORTALITY - NATIONAL LEVEL USING UNLINKED DATA (See Glossary for definitions of italicized terminology)


Numerator: Number of deaths (in the same hospital) that occurred within 30 days of the admission date of

the denominator cases.

Denominator: Number of admissions to hospital for acute non-elective (urgent) care with a primary

diagnosis of acute myocardial infarction from 1 January to 31 December in the specified year. [AMI

diagnostic codes upon separation: ICD-9 410 or ICD-10 I21, I22.]

Please note:

All admissions (including day cases) are to be counted in the denominator including admissions

resulting a) in a transfer to another acute care facility (transfers out) and b) from a transfer from

another acute care facility (transfers in).

AC

37


AC5) AMI 30 DAY MORTALITY - NATIONAL LEVEL - AGE SEX, CO-MORBIDITY ADJUSTED

USING UNLINKED DATA

NOTE:




AC

38


AC6) AMI 30 DAY MORTALITY - HOSPITAL LEVEL USING UNLINKED DATA

NOTE:




AC

39


AC7) HEMORRHAGIC STROKE 30 DAY MORTALITY - NATIONAL LEVEL USING LINKED

DATA





Denominator: The last admission in the specified year for each patient admitted to hospital for acute non-

elective (urgent) care with a principal diagnosis (PDx) of hemorrhagic stroke from 1 January to 31 December

in the specified year. [Hemorrhagic stroke diagnostic codes upon separation: ICD-9 430-432 or ICD-10 I60-

I62.]

Please note only one admission per patient is to be counted in the denominator and the numerator is calculated

by following up all denominator cases for up to 30 days.

AC

40


AC8) HEMORRHAGIC STROKE 30 DAY MORTALITY - NATIONAL LEVEL - AGE, SEX, CO-

MORBIDITY, PREVIOUS AMI ADJUSTED USING LINKED DATA

NOTE:




AC

41


AC9) HEMORRHAGIC STROKE 30-DAY MORTALITY - HOSPITAL LEVEL USING LINKED

DATA

NOTE:




AC

42


AC10) HEMORRHAGIC STROKE 30 DAY MORTALITY - NATIONAL LEVEL USING

UNLINKED DATA



Numerator: Number of deaths in the same hospital that occurred within 30 days of the admission date of the

denominator cases.


diagnosis of hemorrhagic stroke from 1 January to 31 December in the specified year. [Hemorrhagic stroke

diagnostic codes upon separation: ICD-9 430-432 or ICD-10 I60-I62.]

Please note:




AC

43


AC11) HEMORRHAGIC STROKE 30 DAY MORTALITY - NATIONAL LEVEL - AGE SEX, CO-

MORBIDITY ADJUSTED USING UNLINKED DATA

NOTE:




AC

44


AC12) HEMORRHAGIC STROKE 30 DAY MORTALITY - HOSPITAL LEVEL USING

UNLINKED DATA

NOTE:




AC

45


AC13) ISCHEMIC STROKE 30 DAY MORTALITY USING LINKED DATA (See Glossary for definitions of italicized terminology)




Denominator: The last admission in the specified year for each patient admitted to hospital for acute non-

elective (urgent) care with a principal diagnosis (PDx) of ischemic stroke from 1 January to 31 December in

the specified year. [Ischemic stroke diagnostic codes upon separation: ICD-9 433, 434, and 436 or ICD-10

I63-I64.]

Please note only one admission per patient is to be counted in the denominator.

AC

46


AC14) ISCHEMIC STROKE 30 DAY MORTALITY - NATIONAL LEVEL - AGE, SEX, CO-

MORBIDITY, PREVIOUS AMI ADJUSTED USING LINKED DATA

NOTE:




AC

47


AC15) ISCHEMIC STROKE 30-DAY MORTALITY - HOSPITAL LEVEL USING LINKED DATA

NOTE:




AC

48


AC16) ISCHEMIC STROKE 30 DAY MORTALITY - NATIONAL LEVEL USING UNLINKED

DATA



Numerator: Number of deaths in the same hospital that occurred within 30 days of the admission date of the

denominator cases.


diagnosis of ischemic stroke from 1 January to 31 December in the specified year. [Ischemic stroke diagnostic

codes upon separation: ICD-9 433, 434, and 436 or ICD-10 I63-I64.]

Please note:




The numerator is calculated by following up all denominator cases for up to 30 days

AC

49


AC17) ISCHEMIC STROKE 30 DAY MORTALITY - NATIONAL LEVEL - AGE SEX, CO-

MORBIDITY ADJUSTED USING UNLINKED DATA

NOTE:




AC

50


AC18) ISCHEMIC STROKE 30 DAY MORTALITY - HOSPITAL LEVEL USING UNLINKED

DATA

NOTE:




AC

51


AC19) HIP FRACTURE SURGERY INITIATED WITHIN 2 CALENDAR DAYS AFTER

ADMISSION TO THE HOSPITAL



Numerator: Number of denominator cases that were surgically treated (see list of procedures below) within

2 calendar days after admission.

Denominator: Number of people aged 65 years or older admitted to hospital for acute non-elective (urgent)

care with a principal diagnosis (PDx) of upper femur fracture and who were surgically treated (see list of

procedures below) in the same hospital during the specified year [Hip fracture diagnostic codes: ICD-10

S72.0, S72.1, S72.2 or ICD-9 820].

Exclude:

Admissions where the hip fracture occurred during the admission (e.g. hip fracture is coded as a post-

admission diagnosis)

Admissions with missing or invalid procedure date

Technical notes:

Within 2 Calendar Days: for the purposes of calculating the numerator cases the term ‘within 2 calendar

days’ includes cases that were:

Treated on day 0 (same day as admission)

Treated on day 1 (next day)

Treated on day 2

Surgically Treated: for the purposes of calculating the denominator cases the term ‘surgically treated’ refers

to the following list of procedures:

Fixation, hip joint

Application of external fixator device

Implantation of internal device, hip joint

Fixation, femur

Implantation of internal device pelvis

Closed reduction of fracture with internal fixation

Open reduction of fracture with internal fixation

Total hip replacement

Partial hip replacement

Since procedure classifications vary between countries the procedures listed here are not coded. Countries

are requested to map their procedure classification codes to these procedure descriptions and report any

related issues in the comments box in the Sources and Methods section of the questionnaire.

AC

52


MENTAL HEALTH CARE (MH) QUESTIONNAIRE

Indicators in the mental care indicator set include:

1. In-patient death from suicide among patients at the hospital with a mental disorder

2. Death from suicide within 1 year after discharge among patients discharged with a mental disorder

3. Death from suicide within 30 days after discharge among patients discharged with a mental disorder

4. Excess mortality from schizophrenia

5. Excess mortality from bipolar disorder

6. Excess mortality from severe mental illnesses

NOTES

Excess mortality indicators include;

Excess mortality from schizophrenia

Excess mortality from bipolar disorder

Excess mortality from severe mental illnesses

These indicators represent a ratio of two mortality rates (Rate 1 and Rate 2) and aim to measure the excess

mortality from all causes in people who have a diagnosis of the respective condition. Rate 1 for these

indicators equals the “all cause” mortality rate for all persons aged between 15 and 74 years old in the

population diagnosed with the respective condition (schizophrenia, bipolar disorder, severe mental illness.

Rate 2 equals the all-cause mortality rate for all persons aged between 15 and 74 in the total population.

Ideal data source for the denominator population in Rate 1 is a complete register of all people who have ever

had a relevant diagnosis but countries without complete registers should consider and assess the suitability

of following datasets provided they can be linked with mortality data:

• Partial registers (e.g. covering one or more regions)

• Unique patients with a primary or first two listed secondary diagnoses of schizophrenia or bipolar

disorder from combined inpatients/outpatients aggregated data, over a number of years (preferably

at least 5)

• Representative health surveys

• Unique patients prescribed relevant medicines

• Primary care or other patient databases

• Insurance data

MH

53


MH1) IN-PATIENT DEATH FROM SUICIDE AMONG PATIENTS AT THE HOSPITAL WITH A

MENTAL DISORDER


Coverage: Patients aged 15 years and older (5 year age group)

Numerator: Number of patient discharges among denominator cases coded as suicide (ICD-10 codes: X60-

X84) in the year. Please note that only suicide should be included – i.e. suicide attempts and self-harm not

resulting in death should be excluded.

Denominator: Number of patients discharged with a principal diagnosis or first two listed secondary

diagnosis code of mental health and behavioural disorders (ICD-10 codes F10-F69 and F90-99) in the year.

MH

54


MH2) DEATH FROM SUICIDE WITHIN 1 YEAR AFTER DISCHARGE AMONG PATIENTS

DISCHARGED WITH A MENTAL DISORDER


Coverage: Patients aged 15 years and older (5 year age group)

Numerator: Number of patients among denominator cases that committed suicide (ICD-10 codes: X60-X84)

within 1 year after discharge. Please note that only suicide should be included – i.e. suicide attempts and self-

harm not resulting in death should be excluded.

Denominator: Number of patients discharged alive with a principal diagnosis or first two listed secondary


In cases with several admissions during the year, the follow up period starts from the last discharge (discharge

from a hospital and thus not from one department to another).

NB: This indicator requires data that links hospital records with deaths after discharge.

MH

55


MH3) DEATH FROM SUICIDE WTIHIN 30 DAYS AFTER DISCHARGE AMONG PATIENTS

DISCHARGED WITH A MENTAL DISORDER


Coverage: Patients aged 15 years and older (5 years age group)

Numerator: Number of patients among denominator cases that committed suicide (ICD-10 codes:X60-X84)

within 30 days after discharge. Please note that only suicide should be included – i.e. suicide attempts and

self-harm not resulting in death should be excluded.

Denominator: Number of patients discharged alive with a principal diagnosis or first two listed secondary


In cases with several admissions during the year, the follow up period starts from the last discharge (discharge

from a hospital and thus not from one department to another).

NB: This indicator requires data that links hospital records with deaths after discharge.

MH

56


MH4) EXCESS MORTALITY FROM SCHIZOPHRENIA


The indicator will be the ratio of Rate 1: Rate 2

Rate 1: Directly age- and sex-standardised “all cause” mortality rate in the year for all persons aged between

15 and 74 years old in the population with schizophrenia.

Rate 2: Directly age- and sex-standardised “all cause” mortality rate in the same year for all persons aged

between 15 and 74 years old in the total population.

Schizophrenia diagnostic codes:

ICD-9-CM ICD-10-WHO

295.0 Simple type of schizophrenia F20 Schizophrenia

295.1 Disorganised type of schizophrenia F21 Schizotypal disorder

295.2 Catatonic type of schizophrenia F23.1 Acute polymorphic psychotic disorder with symptoms of schizophrenia

295.3 Paranoid type of schizophrenia F23.2 Acute schizophrenia-like psychotic disorder

295.4 Acute schizophrenic episode

295.5 Latent schizophrenia

295.6 Residual schizophrenia

295.7 Schizoaffective type of schizophrenia

295.8 Other specified types of schizophrenia

295.9 Unspecified schizophrenia

F25.0 Schizoaffective disorders

F25.1 Schizoaffective disorder, depressive type

F25.2 Schizoaffective disorder, mixed type

F25.8 Other schizoaffective disorders

F25.9 Schizoaffective disorder, unspecified

Coverage: Patients aged between 15 and 74 years (5 year age groups)

Numerator: All deaths among the denominator population in the year.

Denominator: All people aged 15-74 years ever diagnosed with schizophrenia (see list of ICD codes) as

obtained from a register or equivalent data source in the year.year.

Coverage: People aged between 15 and 74 years (5 year age groups)


Denominator: All people aged 15-74 years in the year.

MH

57


MH5) EXCESS MORTALITY FROM BIPOLAR DISORDER (See Glossary for definitions of italicized terminology)



15 and 74 years old in the population with bipolar disorder.



Bipolar disorder diagnostic codes:

ICD-9-CM ICD-10-WHO

296.4 Bipolar affective disorder, manic F31Bipolar affective disorder

296.5 Bipolar affective disorder, depressed

296.6 Bipolar affective disorder, mixed

296.7 Bipolar affective disorder, unspecified

296.8 Manic depressive psychosis, other and unspecified



Denominator: All people aged 15-74 years ever diagnosed with bipolar disorder (see list of ICD codes) as

obtained from a register or equivalent data source in the year.

.



Denominator: All people aged 15-74 in the year.

MH

58


MH6) EXCESS MORTALITYI FROM SEVERE ILLNESSES (See Glossary for definitions of italicized terminology)



15 and 74 years old in the prevalent population with Severe Mental Illness.





Denominator: All people aged 15-74 years ever diagnosed with SMI as obtained from a register or

equivalent data source in the year.



Denominator: All people aged 15-74 years in the year.

MH

59


PATIENT EXPERIENCES (PE) QUESTIONNAIRE

Indicators in the patient experience indicator set include:

1. Consultation skipped due to costs

2. Medical tests, treatment or follow-up skipped due to costs

3. Prescribed medicine skipped due to costs

4. Waiting time of more than 4 weeks for getting an appointment with a specialist

5. Doctor spending enough time with patient during the consultation

6. Regular doctor spending enough time with patient during the consultation

7. Doctor providing easy-to-understand explanations

8. Regular doctor providing easy-to-understand explanations

9. Doctor giving opportunity to ask questions or raise concerns

10. Regular doctor giving opportunity to ask questions or raise concerns

11. Doctor involving patient in decisions about care and treatment

12. Regular doctor involving patient in decisions about care and treatment

NOTES

PE questionnaire collects weighted rates, and standard errors of the weighted rates by 4 age groups (16-24,

25-44, 45-65 and 65+) and also for the population aged 16 and over as a whole. Weighted rates are calculated

by removing bias from a survey sample, so they are estimates for the survey target population as a whole

and not just for the survey respondents (unweighted rates). Standard errors measure the accuracy of weighted

rates and they should take account of survey sample design. But if not possible, please calculate it using

the following equation:

ij

ijij

ijn

pppSe

)1()(

Where p is the sample proportion, n is the sample size, i is the age group, and j the sex.

If data refer to different age groups or do not strictly comply with the definitions, please indicate this in the

S&M survey. To assess the data comparability based on question phrases and response categories such as

yes/no answer and frequency, please send us the survey questionnaire(s) if your country has not done.

PE

60


PE1) CONSULTATION SKIPPED DUE TO COSTS


Crude rate (weighted) is calculated based on the following definitions. Standard errors should be calculated

based on the sample design.

Coverage: Survey respondents aged 16 and over (4 age groups (16-24, 25-44, 45-65 and 65+) and 16+) who

answered the specific question.

Numerator: Number of survey respondents among denominator cases who answered not having visited a

health professional (e.g., doctor, nurse or allied health professional) because of costs (i.e., actual out-of-

pocket payments for services).

Denominator: Number of survey respondents who answered "Yes" or "No" to a survey question on whether

consultation was skipped due to costs in the reference year.

PE

61


PE2) MEDICAL TESTS, TREATMENT OR FOLLOW-UP SKIPPED DUE TO COSTS






Numerator: Number of survey respondents among denominator cases who answered having skipped a

medical test, treatment (excluding medicines), or other follow-up that was recommended by a health

professional (e.g., doctor, nurse or allied health professional) because of costs (i.e., actual out-of-pocket

payments for services).


recommended medical tests, treatment or follow-up was skipped due to costs in the reference year.

PE

62


PE3) PRESCRIBED MEDICINE SKIPPED DUE TO COSTS






Numerator: Number of survey respondents among denominator cases who answered not having filled a

prescription for medicine/collect a prescription for medicine, or skipped doses of medicine because of costs

(i.e., actual out-of-pocket payments for medicine).


prescribed medicine was skipped due to costs in the reference year.

PE

63


PE4) WAITING TIME OF MORE THAN 4 WEEKS FOR GETTING AN APPOINTMENT WITH

A SPECIALIST






Numerator: Number of survey respondents among denominator cases who reported having waited for four

weeks or more for getting an appointment with a specialist.

Denominator: Number of survey respondents who reported having had an appointment with a specialist in

the reference year and provided a duration of the waiting time.

year.

PE

64


PE5) DOCTOR SPENDING ENOUGH TIME WITH PATIENT DURING THE CONSULTATION



based on the sample design



Numerator: Number of survey respondents among denominator cases who answered that a doctor spent

enough time with them.

Denominator: Number of survey respondents who reported having had a consultation with a doctor in the

reference year and answered "Yes" or "No" to a survey question on whether a doctor spent enough time with

them.

PE

65


PE6) REGULAR DOCTOR SPENDING ENOUGH TIME WITH PATIENT DURING THE

CONSULTATION






Numerator: Number of survey respondents among denominator cases who answered that a regular doctor

always or often spent enough time with them.

Denominator: Number of survey respondents who reported having had a regular doctor in the reference year

and answered a frequency to a survey question on how often a regular doctor spent enough time with them.

PE

66


PE7) DOCTOR PROVIDING EASY-TO-UNDERSTAND EXPLANATIONS






Numerator: Number of survey respondents among denominator cases who answered that a doctor explained

things in a way that was easy to understand.


reference year and answered "Yes" or "No" to a survey question on whether a doctor explained things in a

way that was easy to understand.

PE

67


PE8) REGULAR DOCTOR PROVIDING EASY-TO-UNDERSTAND EXPLANATIONS







always or often explained things in a way that was easy to understand.


and answered a frequency to a survey question on how often a regular doctor explained things in a way that

was easy to understand.

PE

68


PE9) DOCTOR GIVIGN OPPORTUNITY TO ASK QUESTIONS OR RAISE CONCERNS






Numerator: Number of survey respondents among denominator cases who answered that a doctor gave an

opportunity to ask questions or raise concerns about recommended treatment.


reference year and answered "Yes" or "No" to a survey question on whether a doctor gave an opportunity to

ask questions or raise concerns about recommended treatment.

PE

69


PE10) REGULAR DOCTOR GIVING OPPORTUNITY TO ASK QUESTIONS OR RAISE

CONCERNS







always or often gave an opportunity to ask questions or raise concerns about recommended treatment.


and answered a frequency to a survey question on how often a regular doctor gave an opportunity to ask

questions or raise concerns about recommended treatment.

PE

70


PE11) DOCTOR INVOLVING PATIENT IN DECISIONS ABOUT CARE AND TREATMENT






Numerator: Number of survey respondents among denominator cases who answered that a doctor involved

them as much as they wanted to be in decisions about their care and treatment.


reference year and answered "Yes" or "No" to a survey question on whether a doctor involved them as much

as they wanted to be in decisions about their care and treatment.

PE

71


PE12) REGULAR DOCTOR INVOLVING PATIENT IN DECISIONS ABOUT CARE AND

TREATMENT






Numerator: Number of survey respondents among denominator cases who answered that a doctor always

or often involved them as much as they wanted to be in decisions about their care and treatment.


and answered a frequency to a survey question on how often a regular doctor involved them as much as they

wanted to be in decisions about their care and treatment.

PE

72


PATIENT SAFETY (PS) QUESTIONNAIRE

Indicators in the Patient safety indicator (PSI) set include:

1. Retained surgical item or unretrieved device fragment using unlinked data

2. Retained surgical item or unretrieved device fragment using linked data

3. Postoperative pulmonary embolism - hip and knee replacement discharges using unlinked data

4. Postoperative pulmonary embolism - hip and knee replacement discharges using linked data

5. Postoperative pulmonary embolism - hip and knee replacement discharges using linked data and

adjusted for sex and co-morbidity

6. Mortality among hip and knee replacement discharges with postoperative pulmonary embolism

using linked data

7. Postoperative deep vein thrombosis - hip and knee replacement discharges using unlinked data

8. Postoperative deep vein thrombosis - hip and knee replacement discharges using linked data

9. Postoperative deep vein thrombosis - hip and knee replacement discharges using linked data and

adjusted for sex and co-morbidity

10. Mortality among hip and knee replacement discharges with postoperative deep vein thrombosis

using linked data

11. Hip and knee replacement discharges without postoperative pulmonary embolism or deep vein

thrombosis using linked data

12. Mortality among hip and knee replacement discharges without postoperative pulmonary embolism

or deep vein thrombosis using linked data

13. Postoperative sepsis - abdominal discharges using unlinked data

14. Postoperative sepsis - abdominal discharges using linked data

15. Postoperative sepsis - abdominal discharges using linked data and adjusted for age and co-morbidity

16. Post-operative wound dehiscence using unlinked data

17. Post-operative wound dehiscence using linked data

18. Post-operative wound dehiscence using linked data and adjusted for age and co-morbidity

19. Obstetric trauma vaginal delivery with instrument

20. Obstetric trauma vaginal delivery without instrument

PS

73


NOTES

The following abbreviations are used in the indicator algorithms and questionnaire to denote specified data

outputs for the 2018-19 HCQO data collection:

DEN Denominator dataset

LOS

NUM

Length of stay

Numerator dataset

PDX Principal diagnosis

Each indicator includes a flow chart to illustrate calculation steps which may be helpful for countries.

General PSI calculation approach

Figure 9 outlines the general approach to the calculation of PSIs, identifying the denominator population for

each indicator.

Figure 1 GENERAL APPROACH TO CALCULTING PSIS

74


PS1) RETAINED SURGICAL ITEM OR UNRETRIEVED DEVICE FRAGMENT USING

UNLINKED DATA


ICD-9-CM Retained surgical item or unretrieved device fragment diagnosis codes:

9984 Foreign body accidentally left during a procedure

9987 Acute reactions to foreign substance accidentally left during a procedure

Foreign body left in during:

E8710 Surgical operation

E8711 Infusion or transfusion

E8712 Kidney dialysis or other perfusion

E8713 Injection or vaccination

E8714 Endoscopic examination

E8715 Aspiration of fluid or tissue, puncture, and catheterization

E8716 Heart catheterization

E8717 Removal of catheter or packing

E8718 Other specified procedures

E8719 Unspecified procedure

ICD-10-WHO Retained surgical item or unretrieved device fragment diagnosis codes:

T81.5 Foreign body accidentally left in body cavity or operation wound following a

procedure

Coverage: Surgical and medical discharges for patients aged 15 and older

Numerator: Discharges among cases defined in the denominator with ICD code for foreign body left in

during procedure in a secondary diagnosis field during the surgical admission (see ICD codes below).

Denominator: All surgical and medical discharges for patients aged 15 and older.

For relevant procedure codes see Appendix A - Operating Room Procedure Codes, of the following

document:

http://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V44/TechSpecs/PSI%20Appendices.pdf.

Exclude:

PDX - with ICD- code for foreign body left in during procedure in a) the principal diagnosis field

or b) secondary diagnosis present on admission (if known).

LOS - with a length of stay less than 24 hours (in those countries where a timestamp of admission

or discharge is not available, cases with a length of stay of 0 days shall be excluded).

PS

http://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V44/TechSpecs/PSI%20Appendices.pdf

75


T81.6 Acute reaction to foreign substance accidentally left during a procedure

Y61.0 Foreign object accidentally left in body during surgical and medical care: During

surgical operation


infusion or transfusion


kidney dialysis or other perfusion


injection or immunization


endoscopic examination


heart catheterization


aspiration, puncture and other catheterization


removal of catheter or packing


other surgical and medical care


unspecified surgical and medical care

76


Figure 2 RETAINED SURGICAL ITEM OR UNRETRIEVED DEVICE FRAGMENT

ALGORITHM FOR SURGICAL CALCULATION METHOD USING UNLINKED DATA

PDX: principal diagnosis, f body: foreign body, LOS: length of stay, DEN: denominator dataset, SDX: secondary diagnosis, NUM1:

numerator cases based on surgical admission

77


PS2) RETAINED SURGICAL ITEM OR UNRETRIEVED DEVICE FRAGMENT USING LINKED

DATA

NOTE:




PS

78


PS3) POSTOPERATIVE PULMONARY EMBOLISM USING UNLINKED DATA


Hip and knee replacement discharges:

ICD-9-CM Total hip and knee replacement procedure code:

8151 Total hip replacement

8153 Revision of hip replacement

8154 Total knee replacement

Coverage: Hip&knee replacement discharges for patients aged 15 and older.

Numerator: Discharges among cases defined in the denominator with ICD code for pulmonary embolism in

a secondary diagnosis field during the surgical admission (see ICD codes below).

Denominator: Hip and knee replacement discharges, meeting the inclusion and exclusion rules with an ICD

code for an operating room procedure (see figure 11 below).

Surgical discharges:

For relevant codes See Appendix A - Operating Room Procedure Codes#, of the following document:


# Countries which make use of the ICD-10-AM (Australian modification) may consider using surgical DRGs

and the following medical DRGs B60*, B61*, B82* (paraplegia, quadriplegia and spinal cord conditions) if

these are reported with an operating room procedure.

Exclude:

MDC - cases from the numerator and denominator for MDC 14 (Pregnancy, childbirth, and

puerperium) or principal diagnosis in Annex C (Excel sheet - HCQO 2018_19 Data

Collection_Annex A-I)

IVC - Cases from the numerator and denominator where a procedure for interruption of vena cava

or insertion of inferior vena cava filter occurs before or on the same day as the first / main operating

room procedure (hip/knee replacement and all surgical discharges) or where a procedure for

interruption of vena cava is the only operating room procedure (all surgical discharges).

PDX - case with principal diagnosis or secondary diagnosis present on admission (if known) of

pulmonary embolism during the surgical admission (NUM1),

LOS - surgical admissions (NUM1) with length of stay less than 2 days.

PS


79


8155 Revision of knee replacement

ICD-9-CM Pulmonary Embolism diagnosis codes:

4151 Pulmonary embolism

41511 Iatrogenic pulmonary embolism and infarction

41519 Pulmonary embolism and infarction, other

41513 Saddle embolism pulmonary artery

ICD-10-WHO Pulmonary Embolism diagnosis codes:

I26.0 Pulmonary embolism with mention of acute cor pulmonale

I26.9 Pulmonary embolism without mention of acute cor pulmonale

ICD-9-CM Interruption of Vena Cava procedure code:

387 Interruption of vena cava

Percutaneous and open insertion of inferior vena cava filter

Note: Please search for percutaneous and open insertion of IVC filter codes in your country’s version of

procedure coding.

The Australian Classification of Health Interventions (ACHI) codes:

Block [726] 34800-00 Interruption of vena cava

Block [723] 35330-00 Percutaneous insertion of inferior vena cava filter

Block [723] 35330-01 Open insertion of inferior vena cava filter

80


Figure 3 POSTOPERATIVE PULMONARY EMBOLISM

ALGORITHM FOR CALCULATION METHOD USING UNLINKED DATA

OP=IVC: operating procedure for vena cava, PDX: principal diagnosis, PE: pulmonary embolism, LOS: length of stay, DEN:

denominator dataset, SDX: secondary diagnosis, NUM1: numerator cases based on surgical admission

81


PS4) POSTOPERATIVE PULMONARY EMBOLISM USING LINKED DATA

NOTE:




PS

82


PS5) POSTOPERATIVE PULMONARY EMBOLISM USING LINKED DATA AND ADJUSTED

FOR SEX AND CO-MORBIDITY

NOTE:




PS

83


PS6) MORTALITY AMONG HIP AND KNEE REPLACEMENT DISCHARGES WITH

POSTOPERATIVE PULMONARY EMBOLISM USING LINKED DATA

NOTE:




PS

84


PS7) POSTOPERATIVE DEEP VEIN THROMBOSIS USING UNLINKED DATA


Hip and knee replacement discharges:

ICD-9-CM Total hip and knee replacement procedure code:

8151 Total hip replacement

8153 Revision of hip replacement

Coverage: Hip&knee replacement discharges for patients aged 15 and older.

Numerator: Discharges among cases defined in the denominator with ICD code for deep vein thrombosis in

a secondary diagnosis field during the surgical admission (see ICD codes below)

Denominator: Hip and knee replacement discharges, meeting the inclusion and exclusion rules with an ICD

code for an operating room procedure (see figure 12 below).

Surgical discharges:

For relevant codes See Appendix A - Operating Room Procedure Codes#, of the following document:


# Countries which make use of the ICD-10-AM (Australian modification) may consider using surgical DRGs

and the following medical DRGs B60*, B61*, B82* (paraplegia, quadriplegia and spinal cord conditions) if

these are reported with an operating room procedure.

Exclude:




IVC - cases from the numerator and denominator where a procedure for interruption of vena cava

or insertion of inferior vena cava filter occurs before or on the same day as the first / main operating

room procedure (hip/knee replacement and all surgical discharges)

PE - if a patient has both PE and DVT, such case is assigned to PE

PDX - cases with principal diagnosis or secondary diagnosis present on admission (if known) of

deep vein thrombosis during the surgical admission (NUM1)

LOS - surgical admissions (NUM1) with length of stay less than 2 days.

PS


85


8154 Total knee replacement

8155 Revision of knee replacement

ICD-9-CM Deep Vein Thrombosis diagnosis codes:

45111 Phlebitis and thrombosis of femoral vein (deep) (superficial)

45119 Phlebitis and thrombophlebitis of deep vessel of lower extremities – other

4512 Phlebitis and thrombophlebitis of lower extremities

45181 Phlebitis and thrombophlebitis of iliac vein

4519 Phlebitis and thrombophlebitis of other sites – of unspecified site

45340 DVT-embolism lower ext nos (Oct 04)

45341 DVT-emb prox lower ext

45342 DVT-emb distal lower ext

4538 Other venous embolism and thrombosis of other specified veins

ICD-10-WHO Pulmonary Embolism and Deep Vein Thrombosis diagnosis codes:

I80.1 Phlebitis and thrombophlebitis of femoral vein

I80.2 Phlebitis and thrombophlebitis of other deep vessels of lower extremities

I80.3 Phlebitis and thrombophlebitis of lower extremities, unspecified

I80.8 Phlebitis and thrombophlebitis of other sites

I80.9 Phlebitis and thrombophlebitis of unspecified site

I82.8 Embolism and thrombosis of other specified veins

ICD-9-CM Interruption of Vena Cava procedure code:

387 Interruption of vena cava

Percutaneous and open insertion of inferior vena cava filter

Note: Please search for percutaneous and open insertion of IVC filter codes in your country’s version of

procedure coding.

The Australian Classification of Health Interventions (ACHI) codes:

Block [726] 34800-00 Interruption of vena cava

Block [723] 35330-00 Percutaneous insertion of inferior vena cava filter

Block [723] 35330-01 Open insertion of inferior vena cava filter

86


Figure 4 POSTOPERATIVE DEEP VEIN THROMBOSIS


OP=IVC: operating procedure for vena cava, PDX: principal diagnosis, PE: pulmonary embolism, DVT: deep vein thrombosis, LOS:

length of stay, DEN: denominator dataset, SDX: secondary diagnosis, NUM1: numerator cases based on surgical admission,

87


PS8) POSTOPERATIVE DEEP VEIN THROMBOSIS USING LINKED DATA

NOTE:




PS

88


PS9) POSTOPERATIVE DEEP VEIN THROMBOSIS USING LINKED DATA AND ADJUSTED

FOR SEX AND CO-MORBIDITY

NOTE:




PS

89


PS10) MORTALITY AMONG HIP AND KNEE REPLACEMENT DISCHARGES WITH

POSTOPERATIVE DEEP VEIN THROMBOSIS USING LINKED DATA

NOTE:




PS

90


PS11) HIP AND KNEE REPLACEMENT DISCHARGES WITHOUT POSTOPERATIVE

PULMONARY EMBOLISM OR DEEP VEIN THROMBOSIS USING LINKED DATA

NOTE:




PS

91


PS12) MORTALITY AMONG HIP AND KNEE REPLACEMENT DISCHARGES WITHOUT

POSTOPERATIVE PULMONARY EMBOLISM OR DEEP VEIN THROMBOSIS USING LINKED

DATA

NOTE:




PS

92


PS13) POSTOPERATIVE SEPSIS USING UNLINKED DATA


ICD-9-CM Sepsis diagnosis codes:

0380 Streptococcal septicaemia

0381 Staphylococcal septicaemia

03810 Staphylococcal ependence, unspecified

03811 Methicillin susceptible Staphylococcus aureus septicaemia

03812 Methicillin resistant Staphylococcus aureus septicaemia

Coverage: Abdominal discharges for patients aged 15 and older.

Numerator: Discharges among cases defined in the denominator with ICD code for sepsis in a secondary

diagnosis field during the surgical admission (see ICD codes below)

Denominator: Abdominopelvic surgical discharges only, meeting the inclusion and exclusion rules with an

ICD code for an operating room procedure.

Surgical discharges: See Appendix A - Operating Room Procedure Codes#, of the following document:


Abdominopelvic discharges: See Annex F (Excel sheet - HCQO 2018_19 Data Collection_Annex A-I)

Exclude:




INF - cases from numerator and denominator with principal diagnosis of infection or secondary

diagnosis present on admission, if known – see ICD codes below,

IMM/CA - cases from numerator and denominator with any code for immunocompromised state

or cancer – see ICD codes below

PDX - cases with principal diagnosis or diagnosis present on admission (where possible) of sepsis

LOS - length of stay of less than 3 days.

PS


93


03819 Other staphylococcal septicaemia

0382 Pneumococcal ependence (streptococcus pneumoniale ependence)

0383 Septicaemia due to anaerobes

78552 Septic shock

78559 Other shock w/o mention of trauma

9980 Postoperative shock

99800 Postoperative shock, nos

99802 Postoperative shock, septic

Septicaemia due to:

03840 Gram-negative organism, unspecified

03841 Haemophilus influenza

03842 Escherichia coli

03843 Pseudomonas

03844 Serratia

03849 Septicaemia due to other gram-negative organisms

0388 Other specified septicaemias

0389 Unspecified septicaemia

99591 Systemic inflammatory response syndrome due to infectious process w/o organ dysfunction

99592 Systematic inflammatory response syndrome due to infectious process w/organ dysfunction

ICD-10-WHO Sepsis diagnosis codes:

A40.0 Septicaemia due to streptococcus, group a

A40.1 Septicaemia due to streptococcus, group b

A40.2 Septicaemia due to streptococcus, group d

A40.3 Septicaemia due to streptococcus pneumoniae

A40.8 Other streptococcal septicaemia

A40.9 Streptococcal septicaemia, unspecified

A41.0 Septicaemia due to staphylococcus aureus

A41.1 Septicaemia due to other specified staphylococcus

A41.2 Septicaemia due to unspecified staphylococcus

A41.3 Septicaemia due to haemophilus influenza

A41.4 Septicaemia due to anaerobes

A41.5 Septicaemia due to other gram-negative organisms

A41.8 Other specified septicaemia

A41.9 Septicaemia, unspecified

R57.2 Septic shock

R57.8 Other shock

R65.0 Systemic Inflammatory Response Syndrome of infectious origin without organ failure

R65.1 Systemic Inflammatory Response Syndrome of infectious origin with organ failure

94


T81.1 Shock during or resulting from a procedure, not elsewhere classified

Immunocompromised state codes:

ICD-9-CM: See Appendix I – Immunocompromised state diagnosis and procedure codes, of the

following document:


ICD-10-WHO: See Annex G (Excel sheet - HCQO 2018_19 Data Collection_Annex A-I). Please

note the related procedure codes (see ICD-9-CM codes above) are not specified and countries are

requested to search for the relevant codes in their procedure classification systems.

Cancer codes:

ICD-9-CM: See Appendix H – Cancer diagnosis codes, of the following document:


ICD-10-WHO: See Annex H (Excel sheet - HCQO 2018_19 Data Collection_Annex A-I).

Infection codes:

ICD-9-CM: See Appendix F –Infection diagnosis codes, of the following document:


ICD-10-WHO: See Annex I (Excel sheet - HCQO 2018_19 Data Collection_Annex A-I).




95


Figure 5 POSTOPERATIVE SEPSIS


DX/OP=imm/ca: diagnosis or operating procedure immunocompromised satate or cancer, PDX: principal diagnosis, LOS: length of

stay, DEN: denominator dataset, SDX: secondary diagnosis, NUM1: numerator cases based on surgical admission,

96


PS14) POSTOPERATIVE SEPSIS USING LINKED DATA

NOTE:




PS

97


PS15) POSTOPERATIVE SEPSIS USING LINKED DATA AND ADJUSTED FOR AGE AND CO-

MORBIDITY

NOTE:




PS

98


PS16) POSTOPERATIVE WOUND DEHISCENCE USING UNLINKED DATA


ICD-9-CM Reclosure procedure code:

5461 Reclosure postoperative disruption

Immunocompromised state codes:

ICD-9-CM: See Appendix I – Immunocompromised state diagnosis and procedure codes, of the

following document:

http://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V44/TechSpecs/PSI%20Appendices.pdf,

ICD-10-WHO: See Annex G (Excel sheet - HCQO 2018_19 Data Collection_Annex A-I).

Coverage: Abdominal discharges for patients aged 15 and older

Numerator: Discharges among cases defined in the denominator with procedure code for reclosure of

postoperative disruption of abdominal wall (see procedure code below)

Denominator: All abdominopelvic surgical discharges meeting the inclusion and exclusion rules.

See Annex F (Excel sheet - HCQO 2018_19 Data Collection_Annex A-I)

Exclude:

MDC - MDC 14 (Pregnancy, childbirth, and puerperium) or principal diagnosis in Annex C (Excel

sheet - HCQO 2018_19 Data Collection_Annex A-I) from the numerator and denominator.

IMM - Cases from the numerator and denominator with any diagnosis or procedure code for

immunocompromised state –see ICD codes below,

REC - Cases from the numerator and denominator where a procedure for reclosure of postoperative

disruption of abdominal wall occurs before or on the same day as the first abdominopelvic surgery

procedure (Reclos<=date+)

LOS - surgical admissions (NUM1) where length of stay is less than 2 days

PS


99


Figure 6 POSTOPERATIVE WOUND DEHISCENCE

ALGORITHM FOR CALCULTATION METHOD USING UNLINKED DATA

DX/OP=imm: diagnosis or operating procedure immunocompromised state, PDX: principal diagnosis, LOS: length of stay, DEN:

denominator dataset, SDX: secondary diagnosis, NUM1: numerator cases based on surgical admission

100


PS17) POSTOPERATIVE WOUND DEHISCENCE USING LINKED DATA

NOTE:




PS

101


PS18) POSTOPERATIVE WOUND DEHISCENCE USING LINKED DATA AND ADJUSTED FOR

AGE AND CO-MORBIDITY

NOTE:




PS

102


PS19) OBSTETRIC TRAUMA DURING VAGINAL DELIVERY WITH INSTRUMENT


ICD-9-CM Obstetric Trauma diagnosis codes:

66420 Delivery with third degree laceration, unspecified

66421 Delivery with third degree laceration, during delivery

66424 Delivery with third degree laceration, postpartum condition or complication

66430 Trauma to perineum and vulva during delivery, fourth degree perineal laceration



ICD-9-CM Obstetric Trauma procedure codes:

ICD-10-WHO Obstetric Trauma diagnosis codes:

ICD-9-CM Instrument-Assisted Delivery procedure codes:

720 Low forceps operation

721 Low forceps operation w/ episiotomy

7221 Mid forceps operation w/ episiotomy

7229 Other mid forceps operation

7231 High forceps operation w/ episiotomy

7239 Other high forceps operation

724 Forceps rotation of fetal head

7251 Partial breech extraction w/ forceps to aftercoming head

7253 Total breech extraction w/ forceps to aftercoming head

726 Forceps application to aftercoming head

7561 Repair of current obstetric lacerations of bladder and urethra

7562 Repair of current obstetric lacerations of rectum and sphincter

O70.2 Third degree perineal laceration during delivery

O70.3 Fourth degree perineal laceration during delivery

Coverage: Vaginal delivery discharges for patients aged 15 and over.

Numerator: Discharges among cases defined in the denominator with ICD code for 3rd and 4th degree

obstetric trauma in any diagnosis or procedure field (see ICD codes below).

Denominator: All vaginal delivery discharges with any procedure code for instrument-assisted delivery (see

procedure codes below).

PS

103


7271 Vacuum extraction w/ episiotomy

7279 Vacuum extraction delivery nec

* note: delivery admissions must be classified into three categories:

- c-section deliveries (excluded),

- forceps and vacuum assisted deliveries from which this indicator is calculated, and

- all other deliveries (including failed forceps/vaccum, episotomy, etc … and non-instrument) from

which non-instrument indicator is calculated

ICD-9-CM Outcome of delivery codes:

Note: This category is intended for the coding of the outcome of delivery on the mother’s record (Department

of Health and Human Services, 2007)

V27.0 Single liveborn

V27.1 Single stillborn

V27.2 Twins, both liveborn

V27.3 Twins, one liveborn and one stillborn

V27.4 Twins, both stillborn

V27.5 Other multiple birth, all liveborn

V27.6 Other multiple birth, some liveborn

V27.7 Other multiple birth, all stillborn

V27.9 Unspecified outcome of delivery

ICD-10-WHO Outcome of delivery codes:

Note: This category is intended for use as an additional code to identify the outcome of delivery on the

mother’s record.(WHO, 2006)

Z37.0 Single live birth

Z37.1 Single stillbirth

Z37.2 Twins, both liveborn

Z37.3 Twins, one liveborn and one stillborn

Z37.4 Twins, both stillborn

Z37.5 Other multiple births, all liveborn

Z37.6 Other multiple births, some liveborn

Z37.7 Other multiple births, all stillborn

Z37.9 Outcome of delivery, unspecified

104


Figure 7 OBSTETRIC TRAUMA DURING VAGINAL DELIVERY WITH INSTRUMENT ALGORITHM

PDX: principal diagnosis, DEN: denominator dataset, SDX: secondary diagnosis, NUM: numerator cases, OP: procedure code.

105


PS20) OBSTETRIC TRAUMA DURING VAGINAL DELIVERY WITHOUT INSTRUMENT


ICD-9-CM Obstetric Trauma diagnosis codes:

66420 Delivery with third degree laceration, unspecified

66421 Delivery with third degree laceration, during delivery

66424 Delivery with third degree laceration, postpartum condition or complication




ICD-9-CM Obstetric Trauma procedure codes:

ICD-10-WHO Obstetric Trauma diagnosis codes:

ICD-9-CM Instrument-Assisted Delivery procedure codes

720 Low forceps operation

721 Low forceps operation w/ episiotomy

7221 Mid forceps operation w/ episiotomy

7229 Other mid forceps operation

7231 High forceps operation w/ episiotomy

7239 Other high forceps operation

724 Forceps rotation of fetal head

7251 Partial breech extraction w/ forceps to aftercoming head

7561 Repair of current obstetric lacerations of bladder and urethra

7562 Repair of current obstetric lacerations of rectum and sphincter

O70.2 Third degree perineal laceration during delivery

O70.3 Fourth degree perineal laceration during delivery

Coverage: Vaginal delivery discharges for patients aged 15 and over.

Numerator: Discharges among cases defined in the denominator with ICD code for 3rd and 4th degree

obstetric trauma in any diagnosis or procedure field (see ICD codes below).

Denominator: All vaginal delivery discharge patients.

Exclude cases: with instrument-assisted delivery.

PS

106


7253 Total breech extraction w/ forceps to aftercoming head

726 Forceps application to aftercoming head

7271 Vacuum extraction w/ episiotomy

7279 Vacuum extraction delivery nec

728* Other specified instrumental delivery

729* Unspecified instrumental delivery

* Failed vacuum extraction, failed forceps, assisted breech delivery, episiotomy, incision of cervix and

symphysiotomy procedures are not included in the Instrument Assisted Delivery Procedures code list.

Therefore, these procedures are excluded from the definition of the ‘with instrument’ indicator and

conversely included in the definition of the ‘without instrument’ indicator.

ICD-9-CM Outcome of delivery codes:

Note: This category is intended for the coding of the outcome of delivery on the mother’s record.

(Department of Health and Human Services, 2007)

V27.0 Single liveborn

V27.1 Single stillborn

V27.2 Twins, both liveborn

V27.3 Twins, one liveborn and one stillborn

V27.4 Twins, both stillborn

V27.5 Other multiple birth, all liveborn

V27.6 Other multiple birth, some liveborn

V27.7 Other multiple birth, all stillborn

V27.9 Unspecified outcome of delivery

ICD-10-WHO Outcome of delivery codes:

Note: This category is intended for use as an additional code to identify the outcome of delivery on the

mother’s record (WHO, 2006).

Z37.0 Single live birth

Z37.1 Single stillbirth

Z37.2 Twins, both liveborn

Z37.3 Twins, one liveborn and one stillborn

Z37.4 Twins, both stillborn

Z37.5 Other multiple births, all liveborn

Z37.6 Other multiple births, some liveborn

Z37.7 Other multiple births, all stillborn

Z37.9 Outcome of delivery, unspecified

107


Figure 8 OBSTETRIC TRAUMA DURING VAGINAL DELIVERY WITHOUT INSTRUMENT

ALGORITHM

PDX: principal diagnosis, DEN: denominator dataset, SDX: secondary diagnosis, NUM: numerator cases, OP: procedure code.

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